Healthcare Provider Details

I. General information

NPI: 1477092468
Provider Name (Legal Business Name): SKYLAR BLAINE MCKINNEY NAGY LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SKYLAR MCKINNEY LCPC

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E WILLOW AVE
WHEATON IL
60187-5426
US

IV. Provider business mailing address

222 E WILLOW AVE
WHEATON IL
60187-5426
US

V. Phone/Fax

Practice location:
  • Phone: 630-784-4800
  • Fax:
Mailing address:
  • Phone: 630-784-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180010733
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180010733
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: